New Delhi: India missed detecting nearly 3 lakh tuberculosis (TB) cases in 2019, according to India TB report 2020 released by the Union health ministry Wednesday. This is the least number of missed TB cases India has ever recorded, and a significant improvement from the 10 lakh cases that were missed in 2017.
Missing TB cases are an important metric for disease control as undiagnosed, untreated cases may spread the infection in the community.
According to the report, the World Health Organisation (WHO) estimated India’s TB cases in 2019 at 26.9 lakh. However, India’s TB notification — which gives the number of patients registered with the Central TB Division — saw 24.04 lakh TB patients. This means that 2.86 lakh cases were missed in the year.
Nevertheless, India’s TB notification jumped to its highest figure — an 11.6 per cent rise over 2018.
The report comes at a time India recorded over 4.73 lakh Covid-19 cases and nearly 15,000 deaths since the pandemic hit the country.
TB kills around 4.8 lakh Indians every year, or about 1,400 people daily, according to estimates from the National Strategic Plan for TB Elimination (2017-25).
However, the official figure for TB deaths, according to the health ministry report, was 79,000 in 2018. This is the latest available figure.
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Like Covid-19, TB is an infectious disease which usually affects the lungs. Despite being completely curable and largely preventable, India has struggled to control the spread of this disease. It has the highest TB burden as well — responsible for over one-fourth of the world’s cases and one-third of the deaths.
‘Should not shift focus from TB’
At a press conference to launch the report, Union Health Minister Harsh Vardhan Wednesday stressed the importance of keeping the focus on tuberculosis. “Despite the coronavirus pandemic, I have maintained that the focus should not shift from tuberculosis,” he said.
However, if coronavirus, which doesn’t have a treatment yet, can be tackled, then India can win the fight against TB, which is ancient and with a known cure, Harsh Vardhan added.
India has set the target of eliminating tuberculosis by 2025, five years before the global target.
“The rise in notifications sounds impressive but the detection of new cases have nosedived in the last four months of the (Covid) pandemic,” said Dr Yogesh Jain, cofounder of Jan Swasthya Sahyog, a subsidised healthcare service that caters to rural Chhattisgarh. Jain has written extensively about gaps in India’s TB care.
His hospital saw the number of new TB cases decrease from 50 a day to about 10 since the beginning of the lockdown.
ThePrint’s had earlier reported how Covid-19 had led to an 80 per cent decrease in notifications in April and severely impacted patient services like free drugs and treatment.
The rise in notifications
The latest TB report, which carries data from January to December 2019, showed that about 6.79 lakh notifications of India’s total cases, or about 28 per cent, were diagnosed in the private sector — a rise of 25 per cent over 2018.
India has a public-private partnership, called Patient Providers Support Agency programme, running in 173 districts.
The five states of Uttar Pradesh (20 per cent), Maharashtra (9 per cent), Madhya Pradesh (8 per cent), Rajasthan (7 per cent) and Bihar (7 per cent) were responsible for half the total notifications.
Out of the total notified patients, 95 per cent were put on treatment in 2019. In 2018, the treatment success rate was 80 per cent, while 4 per cent died, 4 per cent were lost to follow up and 7 per cent were not evaluated. The data for 2019 isn’t available yet.
A number of factors like free drugs in the private sector, expansion of diagnostic tests, close engagement with private doctors and mandatory notification played an important role in the jump in notifications.
Moreover, a five-fold increase in funding for TB — from Rs 640 crore in 2016-17 to Rs 2,443 crore in 2019-20, nearly the entire budget the National TB elimination programme requested — also made the difference.
There are 1,180 test facilities that can detect resistance to first-line drug rifampicin at the district and sub-district levels. This led to 35.31 lakh CBNAAT tests being performed, an increase of 47 per cent from 2018, leading to detection of 9.9 lakh cases.
CBNAAT, or the Cartridge-based Nucleic Acid Amplification Test, gives results in two hours, and is considered to be more sensitive than smear microscopy, which is traditionally used to detect TB.
“Very soon each block will have a molecular testing facility and 6,000 such (CBNAAT) machines are expected,” Dr K.S. Sachdeva, additional director general, Central TB division, said at the press meet.
Drug-resistant tuberculosis still a concern
Multi drug-resistant tuberculosis (MDR TB) is a severe form of the disease, which is resistant to two of the most common first-line TB drugs, rifampicin and isoniazid.
In 2019, India diagnosed 66,359 such cases and put 56,500 (85 per cent) of them on treatment. This is an increase of 7.6 per cent over last year.
However, the WHO report estimates that India has about 1,30,000 drug-resistant cases, which means that 51 per cent of them are undiagnosed and 56 per cent of them are not receiving treatment.
The treatment success for conventional MDR TB in 2019 was 48 per cent, with 19 per cent deaths. For XDR TB, an even more severe form of the disease, treatment was 37 per cent successful, with 38 per cent deaths.
India had introduced an all-oral regimen for all drug-resistant TB patients in September 2019, and a nine-month MDR TB regimen instead of the 24 months earlier.
Those on shorter MDR TB regimen showed a better success rate with 60 per cent of patients being treated successfully, with 13 per cent deaths.
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